Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지
DOI QR코드

DOI QR Code

Routine Follow-Up Biopsies after Complete Endoscopic Resection for Early Gastric Cancer May Be Unnecessary

  • Received : 2012.03.26
  • Accepted : 2012.05.14
  • Published : 2012.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Local recurrence, due to residual tumor, may occur after endoscopic resection for early gastric cancer. The aims of this study are to evaluate the predictive factors for local recurrence, and suggest an appropriate follow-up biopsy strategy. Materials and Methods: We retrospectively reviewed 396 early gastric cancers from 372 consecutive patients, who underwent endoscopic resection between January 2002 and April 2008. Cumulative recurrence rates were determined by the Kaplan-Meier method, and Cox proportional hazard analysis was used to determine the risk factors for local recurrence. Results: Local recurrence at the endoscopic resection site was found in 17 cases, among the total 396 lesions, during a median follow-up period of 48 months. The 5-year cumulative local recurrence rate was 4.8%. Multivariate analyses determined that tumor involvement at the lateral resection margin [hazard ratio: 35.9; P<0.001], uncheckable lateral resection margin [hazard ratio: 16.8; P<0.001], uncheckable or involved deep resection margin [hazard ratio: 3.76; P=0.047], and piecemeal resection [hazard ratio: 3.95; P=0.007] were associated with local recurrence. If a lesion was positive for any of these risk factors, the 5-year cumulative recurrence rate was 27.0%, while local recurrence was not found in any lesion that lacked these risk factors. Most episodes of recurrence were found during the first or second follow-up endoscopic biopsy at the ulcer scar. Conclusions: Routine follow-up biopsies at the endoscopic resection site might be unnecessary in cases where an early gastric cancer lesion was endoscopically resected en bloc with tumor-free lateral and deep margins.

Keywords

References

  1. Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001;48:225-229. https://doi.org/10.1136/gut.48.2.225
  2. Oda I, Saito D, Tada M, Iishi H, Tanabe S, Oyama T, et al. A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 2006;9:262-270. https://doi.org/10.1007/s10120-006-0389-0
  3. Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T, et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 2006;64:877-883. https://doi.org/10.1016/j.gie.2006.03.932
  4. Tanabe S, Koizumi W, Mitomi H, Nakai H, Murakami S, Nagaba S, et al. Clinical outcome of endoscopic aspiration mucosectomy for early stage gastric cancer. Gastrointest Endosc 2002;56:708-713. https://doi.org/10.1016/S0016-5107(02)70121-1
  5. Miyamoto S, Muto M, Hamamoto Y, Boku N, Ohtsu A, Baba S, et al. A new technique for endoscopic mucosal resection with an insulated-tip electrosurgical knife improves the completeness of resection of intramucosal gastric neoplasms. Gastrointest Endosc 2002;55:576-581. https://doi.org/10.1067/mge.2002.122579
  6. Manner H, Rabenstein T, May A, Pech O, Gossner L, Werk D, et al. Long-term results of endoscopic resection in early gastric cancer: the Western experience. Am J Gastroenterol 2009;104:566-573. https://doi.org/10.1038/ajg.2008.151
  7. Noda M, Kodama T, Atsumi M, Nakajima M, Sawai N, Kashima K, et al. Possibilities and limitations of endoscopic resection for early gastric cancer. Endoscopy 1997;29:361-365. https://doi.org/10.1055/s-2007-1004216
  8. Watanabe K, Ogata S, Kawazoe S, Watanabe K, Koyama T, Kajiwara T, et al. Clinical outcomes of EMR for gastric tumors: historical pilot evaluation between endoscopic submucosal dissection and conventional mucosal resection. Gastrointest Endosc 2006;63:776-782. https://doi.org/10.1016/j.gie.2005.08.049
  9. Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 2009;58:331-336. https://doi.org/10.1136/gut.2008.165381
  10. Goto O, Fujishiro M, Kodashima S, Ono S, Omata M. Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy 2009;41:118-122. https://doi.org/10.1055/s-0028-1119452
  11. Takenaka R, Kawahara Y, Okada H, Hori K, Inoue M, Kawano S, et al. Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection. Gastrointest Endosc 2008;68:887-894. https://doi.org/10.1016/j.gie.2008.03.1089
  12. Jang JS, Choi SR, Qureshi W, Kim MC, Kim SJ, Jeung JS, et al. Long-term outcomes of endoscopic submucosal dissection in gastric neoplastic lesions at a single institution in South Korea. Scand J Gastroenterol 2009;44:1315-1322. https://doi.org/10.3109/00365520903254304
  13. Miyata M, Yokoyama Y, Okoyama N, Joh T, Seno K, Sasaki M, et al. What are the appropriate indications for endoscopic mucosal resection for early gastric cancer? Analysis of 256 endoscopically resected lesions. Endoscopy 2000;32:773-778. https://doi.org/10.1055/s-2000-7712
  14. Tada M, Inoue H, Yabata E, Okabe S, Endo M. Colonic mucosal resection using a transparent cap-fitted endoscope. Gastrointest Endosc 1996;44:63-65. https://doi.org/10.1016/S0016-5107(96)70231-6
  15. Choi IJ, Kim CG, Chang HJ, Kim SG, Kook MC, Bae JM. The learning curve for EMR with circumferential mucosal incision in treating intramucosal gastric neoplasm. Gastrointest Endosc 2005;62:860-865. https://doi.org/10.1016/j.gie.2005.04.033
  16. Lee JY, Choi IJ, Cho SJ, Kim CG, Kook MC, Lee JH, et al. Endoscopic submucosal dissection for metachronous tumor in the remnant stomach after distal gastrectomy. Surg Endosc 2010;24:1360-1366. https://doi.org/10.1007/s00464-009-0779-6
  17. Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma - 2nd English Edition - Gastric Cancer 1998;1:10-24.
  18. Hamilton SR, Aaltonen LA, eds. World Health Organization classification of tumours. Pathology and genetics of tumours of the digestive system. Lyon: IARC Press; 2000.
  19. Schlemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawsey SM, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000;47:251-255. https://doi.org/10.1136/gut.47.2.251
  20. Soetikno R, Kaltenbach T, Yeh R, Gotoda T. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol 2005;23:4490-4498. https://doi.org/10.1200/JCO.2005.19.935
  21. Kim JJ, Lee JH, Jung HY, Lee GH, Cho JY, Ryu CB, et al. EMR for early gastric cancer in Korea: a multicenter retrospective study. Gastrointest Endosc 2007;66:693-700. https://doi.org/10.1016/j.gie.2007.04.013
  22. Dinis-Ribeiro M, Pimentel-Nunes P, Afonso M, Costa N, Lopes C, Moreira-Dias L. A European case series of endoscopic submucosal dissection for gastric superficial lesions. Gastrointest Endosc 2009;69:350-355. https://doi.org/10.1016/j.gie.2008.08.035
  23. Lee H, Yun WK, Min BH, Lee JH, Rhee PL, Kim KM, et al. A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer. Surg Endosc 2011;25:1985-1993. https://doi.org/10.1007/s00464-010-1499-7
  24. Ono H. Early gastric cancer: diagnosis, pathology, treatment techniques and treatment outcomes. Eur J Gastroenterol Hepatol 2006;18:863-866. https://doi.org/10.1097/00042737-200608000-00009
  25. Nakamoto S, Sakai Y, Kasanuki J, Kondo F, Ooka Y, Kato K, et al. Indications for the use of endoscopic mucosal resection for early gastric cancer in Japan: a comparative study with endoscopic submucosal dissection. Endoscopy 2009;41:746-750. https://doi.org/10.1055/s-0029-1215010
  26. Park JC, Lee SK, Seo JH, Kim YJ, Chung H, Shin SK, et al. Predictive factors for local recurrence after endoscopic resection for early gastric cancer: long-term clinical outcome in a singlecenter experience. Surg Endosc 2010;24:2842-2849. https://doi.org/10.1007/s00464-010-1060-8
  27. Uedo N, Iishi H, Tatsuta M, Ishihara R, Higashino K, Takeuchi Y, et al. Longterm outcomes after endoscopic mucosal resection for early gastric cancer. Gastric Cancer 2006;9:88-92. https://doi.org/10.1007/s10120-005-0357-0
  28. Nakajima T, Oda I, Gotoda T, Hamanaka H, Eguchi T, Yokoi C, et al. Metachronous gastric cancers after endoscopic resection: how effective is annual endoscopic surveillance? Gastric Cancer 2006;9:93-98. https://doi.org/10.1007/s10120-006-0372-9
  29. Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kanao H, et al. Endoscopic submucosal dissection for residual/local recurrence of early gastric cancer after endoscopic mucosal resection. Endoscopy 2006;38:996-1000. https://doi.org/10.1055/s-2006-944780
  30. Yokoi C, Gotoda T, Hamanaka H, Oda I. Endoscopic submucosal dissection allows curative resection of locally recurrent early gastric cancer after prior endoscopic mucosal resection. Gastrointest Endosc 2006;64:212-218. https://doi.org/10.1016/j.gie.2005.10.038
  31. Sohn YJ, Jang JS, Choi SR, Kwon HC, Jung GJ, Kim MC, et al. Early detection of recurrence after endoscopic treatment for early gastric cancer. Scand J Gastroenterol 2009;44:1109-1114.

Cited by

  1. Risk Factors for Local Recurrence of Early Gastric Cancer after Endoscopic Submucosal Dissection vol.85, pp.3, 2013, https://doi.org/10.3904/kjm.2013.85.3.285
  2. Endoscopic Gastric Cancer Screening and Surveillance in High-Risk Groups vol.47, pp.6, 2012, https://doi.org/10.5946/ce.2014.47.6.497
  3. Endoscopic Submucosal Dissection for Gastrointestinal Superficial Lesions: Initial Experience in a Single Portuguese Center vol.22, pp.5, 2012, https://doi.org/10.1016/j.jpge.2015.05.001
  4. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a comparison study to surgery using propensity score-matched analysis vol.30, pp.9, 2016, https://doi.org/10.1007/s00464-015-4672-1
  5. Lymph node metastasis risk according to the depth of invasion in early gastric cancers confined to the mucosal layer vol.19, pp.3, 2016, https://doi.org/10.1007/s10120-015-0535-7
  6. Discrepancy between Clinical and Final Pathological Evaluation Findings in Early Gastric Cancer Patients Treated with Endoscopic Submucosal Dissection vol.16, pp.1, 2012, https://doi.org/10.5230/jgc.2016.16.1.34
  7. Endoscopic prediction of recurrence in patients with early gastric cancer after margin‐negative endoscopic resection vol.31, pp.7, 2012, https://doi.org/10.1111/jgh.13301
  8. Gastrointestinal: Gastric mixed adenoneuroendocrine carcinoma vol.31, pp.7, 2012, https://doi.org/10.1111/jgh.13302
  9. Development of Metachronous Tumors after Endoscopic Resection for Gastric Neoplasm according to the Baseline Tumor Grade at a Health Checkup Center vol.70, pp.5, 2012, https://doi.org/10.4166/kjg.2017.70.5.223
  10. Serial intermediate-term quality of life comparison after endoscopic submucosal dissection versus surgery in early gastric cancer patients vol.32, pp.4, 2012, https://doi.org/10.1007/s00464-017-5909-y
  11. Helicobacter pylori Therapy for the Prevention of Metachronous Gastric Cancer vol.378, pp.12, 2012, https://doi.org/10.1056/nejmoa1708423
  12. Endoscopic predictive factors associated with local recurrence after gastric endoscopic submucosal dissection vol.53, pp.8, 2018, https://doi.org/10.1080/00365521.2018.1484153
  13. Evaluation of Submucosal or Lymphovascular Invasion Detection Rates in Early Gastric Cancer Based on Pathology Section Interval vol.20, pp.2, 2020, https://doi.org/10.5230/jgc.2020.20.e14
  14. Clinical significance of regional lymph node enlargement in patients with EGC within the expanded criteria for ESD vol.20, pp.None, 2012, https://doi.org/10.1186/s12876-020-01197-z